For individuals with celiac disease, the wheat protein gluten, which lurks hidden in a variety of seemingly unlikely food products, is the ultimate enemy. If you have celiac disease and have had to deal with either reading the label on everything you eat or living with incapacitating abdominal pain and a host of other symptoms, you are probably on the lookout for anything that might make living with this difficult disease easier. Vitamin D, a nutrient essential to bone health, has been touted as protecting against everything from cancer to multiple sclerosis. Unfortunately, there's no evidence that it helps with gluten digestion, but the relationship between vitamin D and celiac disease is an important one.
Why Can't I Digest Gluten?
Gluten is a protein found in wheat, rye, barley and sometimes oats. It is also a common additive in many packaged foods, medicines, and health and beauty products. Gluten is resistant to digestion in everyone. If you have celiac disease, certain genes make your body react to ingested gluten as if it were a harmful pathogen. Inflammatory chemicals, not just in the intestine but all over your body, get released, causing a multitude of symptoms. Within the intestine, the inflammation damages the cells of the villi that are responsible for absorbing nutrients from food into your bloodstream. Under a microscope the villi appear short and blunted, a hallmark of the disease.
Can Vitamin D Help?
While vitamin D has not yet been shown to help with celiac disease or improve tolerance to gluten, it does seem to have a role in inhibiting inflammation in the gastrointestinal tract. As reported in the December 2003 issue of "Molecular Endocrinology," when experimenters at Penn State University bred mice without vitamin D receptors in their GI tracts, the mice developed severe inflammatory bowel disease and died. The active form of vitamin D has also been shown to decrease the release of immune cells and inflammatory chemicals in test tube models. It is possible, then, that Vitamin D could help with celiac disease symptoms, but more research is needed.
Celiac, Vitamin D and Bone Disease
While vitamin D's capability to offset celiac disease isn't clear, its role in bone health is. Vitamin D significantly increases the intestine's ability to absorb calcium, which is needed to make bones strong. Bone disease is common in people with celiac disease and seems to be a complex process. It is partly related, again, to bodywide inflammation, but it also has to do with a reduced ability of the absorptive cells to uptake both vitamin D and calcium as a result of damage caused by gluten. Because people with celiac are not able to use dietary vitamin D and calcium properly, they require higher amounts of these nutrients in their diets to keep their bones healthy.
How Much Vitamin D?
Researchers disagree about how much dietary vitamin D is optimal and even about what constitutes a normal blood level. However, since people with celiac disease absorb vitamin D poorly, it makes sense that they should take in more than the general population. In 2010, the Institute of Medicine released new dietary reference intakes of vitamin D for Americans. The guideline is 600 international units for everyone aged 1 to 70 and 800 IU for those older than 70.
The upper limit has been set at 4,000 IU for adults and children over 9. If you have celiac disease, you should probably get an amount somewhere between the DRI and the upper limit for your age. Since food sources of vitamin D are hard to come by and sunscreen prevents vitamin D synthesis by the skin, you will likely need a supplement to obtain enough, as well as at least 1,000 milligrams of calcium per day or 1,300 milligrams for teens, women over 50, and pregnant or lactating women.
People with celiac disease are also often lactose intolerant, ruling out milk as an absorbable source of both nutrients. Above all, the most important recommendation to follow if you have celiac disease, both to minimize symptoms and maximize bone health, remains to completely avoid gluten in your diet.
References
- "Alternative Medicine Review"; Use of Vitamin D in Clinical Practice; J. Cannell, M.D., et al.; 2008
- "Molecular Endocrinology"; A Crucial Role for the Vitamin D Receptor in Experimental Inflammatory Bowel Disease; M. Froicu, et al.; December 2003
- "Alternative Medicine Review"; Digestive and Nutritional Considerations in Celiac Disease: Could Supplementation Help?; Tom Malterre; 2009
- Dietary Reference Intakes for Calcium and Vitamin D; Institute of Medicine; November 2010
- National Digestive Diseases Information Clearinghouse: Celiac Disease
- Vitamin D Council
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